Clin Endosc.  2022 Nov;55(6):760-766. 10.5946/ce.2021.269.

Underestimation of endoscopic size in large gastric epithelial neoplasms

• Song JS
• Kim BS
• Yang MA
• Lee YJ
• Jung GM
• Kim JW
• Cho JW

• KMID: 2536076
• DOI: http://doi.org/10.5946/ce.2021.269

Abstract

Background/Aims
Endoscopic submucosal dissection (ESD) is an effective method for resecting gastric adenomas and adenocarcinomas. A significant discrepancy was observed between endoscopic and pathological sizes in samples obtained from patients undergoing ESD. This study elucidates the factors affecting size discrepancy after formalin fixation.
Methods
The records of 64 patients with 69 lesions were analyzed, including 50 adenomas and 19 adenocarcinomas. Data on location, gross shape, histology, and size after fixation in formalin were collected.
Results
The mean size of the resected specimen appeared to decrease after formalin fixation (37.5 mm prefixation vs. 35.8 mm postfixation, p<0.05). The mean long axis diameter of the lesions was 20.3±7.9 mm prefixation and 13.4±7.9 mm postfixation. Size differences in lesions smaller than 20 mm were significantly greater than those in lesions larger than 20 mm (7.6±5.6 mm vs. 2.5±5.8 mm, p<0.01). In multivariate analysis, a tumor size of ≥20 mm was found to be an independent factor affecting size postformalin fixation (p<0.05).
Conclusions
The endoscopic size of lesions before ESD may be underestimated in tumors larger than 20 mm in size. Therefore, increased attention must be paid during ESD to avoid instances of incomplete resection.

Keyword

Endoscopy; Neoplasms; Stomach

Reference

1. Chung IK, Lee JH, Lee SH, et al. Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study. Gastrointest Endosc. 2009; 69:1228–1235.

2. Min BH, Kim ER, Kim KM, et al. Surveillance strategy based on the incidence and patterns of recurrence after curative endoscopic submucosal dissection for early gastric cancer. Endoscopy. 2015; 47:784–793.

3. Siu KF, Cheung HC, Wong J. Shrinkage of the esophagus after resection for carcinoma. Ann Surg. 1986; 203:173–176.

4. Goldstein NS, Soman A, Sacksner J. Disparate surgical margin lengths of colorectal resection specimens between in vivo and in vitro measurements: the effects of surgical resection and formalin fixation on organ shrinkage. Am J Clin Pathol. 1999; 111:349–351.

5. Kim EH, Park JC, Song IJ, et al. Prediction model for non-curative resection of endoscopic submucosal dissection in patients with early gastric cancer. Gastrointest Endosc. 2017; 85:976–983.

6. Gotoda T, Yanagisawa A, Sasako M, et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer. 2000; 3:219–225.

7. Cho JW. The role of endosonography in the staging of gastrointestinal cancers. Clin Endosc. 2015; 48:297–301.

8. Shim CN, Song MK, Kang DR, et al. Size discrepancy between endoscopic size and pathologic size is not negligible in endoscopic resection for early gastric cancer. Surg Endosc. 2014; 28:2199–2207.

9. Asada-Hirayama I, Kodashima S, Goto O, et al. Factors predictive of inaccurate determination of horizontal extent of intestinal-type early gastric cancers during endoscopic submucosal dissection: a retrospective analysis. Dig Endosc. 2013; 25:593–600.

10. Sohn YJ, Jang JS, Choi SR, et al. Early detection of recurrence after endoscopic treatment for early gastric cancer. Scand J Gastroenterol. 2009; 44:1109–1114.

11. Yamamoto Y, Fujisaki J, Hirasawa T, et al. Therapeutic outcomes of endoscopic submucosal dissection of undifferentiated-type intramucosal gastric cancer without ulceration and preoperatively diagnosed as 20 millimetres or less in diameter. Dig Endosc. 2010; 22:112–118.

12. Schoen RE, Gerber LD, Margulies C. The pathologic measurement of polyp size is preferable to the endoscopic estimate. Gastrointest Endosc. 1997; 46:492–496.

13. Fennerty MB, Davidson J, Emerson SS, et al. Are endoscopic measurements of colonic polyps reliable? Am J Gastroenterol. 1993; 88:496–500.

14. Gopalswamy N, Shenoy VN, Choudhry U, et al. Is in vivo measurement of size of polyps during colonoscopy accurate? Gastrointest Endosc. 1997; 46:497–502.

15. Yun GW, Kim JH, Lee YC, et al. What are the risk factors for residual tumor cells after endoscopic complete resection in gastric epithelial neoplasia? Surg Endosc. 2015; 29:487–492.

16. Kim SB, Lee SH, Bae SI, et al. Association between Helicobacter pylori status and metachronous gastric cancer after endoscopic resection. World J Gastroenterol. 2016; 22:9794–9802.